© Georg Thieme Verlag KG Stuttgart · New York
Verruciform xanthoma of the esophagus: an uncommon entity in an unusual site
17 December 2010 (online)
A 49-year-old man was admitted for medical examination because of epigastric discomfort. Esophagogastroscopy revealed a small, elevated, verrucoid pink-yellowish mucosal lesion, 3 mm in diameter, in the upper third of the esophagus ([Fig. 1]).
Fig. 1 Esophagogastroscopy showing a small, elevated, granular/verrucoid pink-yellowish lesion, 3 mm in diameter, in the mucosa of the upper third of the esophagus.
Low power histological examination revealed an exophytic lesion resembling a squamous papilloma, with the typical papillomatosis, acanthosis, and hyperparakeratosis of the esophageal squamous epithelium ([Fig. 2 a]).
Fig. 2 a Low power histological section showing papillomatosis, acanthosis, and hyperparakeratosis of the squamous epithelium, as usually seen in squamous papilloma (hematoxylin and eosin, original magnification × 40). b, c At higher magnification, the subepithelial connective tissue appears infiltrated by clear cells with foamy cytoplasm and small nuclei with no atypia (hematoxylin and eosin, original magnification: b × 200; c × 400). d There is diffuse and strong positivity for CD68 on immunostaining (original magnification × 400).
At higher magnification, neutrophilic intraepithelial exocytosis was observed, and the subepithelial connective tissue appeared infiltrated by clear cells with foamy cytoplasm and small nuclei with no atypia ([Fig. 2 b, c]). At immunohistochemistry, the foamy cells were negative for cytokeratins, s-100 protein, and CD1a, while CD68 was strongly positive ([Fig. 2 d]), indicating the histiocytic nature of the cells. The histological and immunohistochemical features allowed making a diagnosis of verruciform xanthoma of the esophagus.
Verruciform xanthoma is a lesion characteristically described in the oral cavity and genital skin . It is usually solitary, but cases of multifocal lesions have been reported . The main histological feature is the presence of foamy histiocytes in the subepithelial stroma of a squamous epithelium displaying papillomatosis, acanthosis, and hyperkeratosis, as observed in papillomatous/verrucous lesions. Intraepithelial neutrophilic infiltration is another hallmark. The etiology is still unknown, most cases being unrelated to a viral infection. The presence of human papilloma virus in the epithelial cells has been demonstrated in only two reported lesions in the oral mucosa  and scrotum . To the best of our knowledge, our case represents the second description in the English literature of verruciform xanthoma in the esophagus .
Competing interests: None
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Dr. S. Licci
Department of Pathology
Santo Spirito Hospital
Lungotevere in Sassia, 1